Monocular blindness secondary to calcific embolization. An unusual presentation of rheumatic mitral valvular disease

Calcific retinal embolism as an indicator of severe unrecognised cardiovascular disease

OBJECTIVE

To describe the association between calcific retinal embolism (CRE) and cardiac valve stenosis.

DESIGN AND SETTING

Retrospective chart review of patients with clinical criteria for CRE.

PATIENTS

24 patients with CRE who underwent two dimensional echocardiography between 1976 and 1998.

RESULTS

Nine patients (38%) had calcific valve stenosis, which was haemodynamically severe in five patients (four aortic and one mitral), four of whom had no cardiac symptoms. Six patients underwent surgical intervention (aortic valve replacement in three patients, mitral and aortic valve replacement in one patient, removal of calcific cardiac pseudotumour in one patient, and carotid endarterectomy in one patient).

CONCLUSIONS

CRE may be the presenting feature of otherwise asymptomatic, clinically important underlying cardiovascular disease and, in particular, haemodynamically severe calcific valve stenosis.

Spontaneous calcific coronary embolisation: necropsy x-ray study

Thirty-one hearts with advanced calcification of one or both left heart valves were investigated for the presence of spontaneous calcific emboli. X-ray (Mammograf) showed coronary emboli in 14 cases, that is, in 45% of the whole series. In seven cases (23%) calcific particles were also present in the left ventricular cavity. A total of 265 calcific emboli (205 intracoronary plus 60 intravenous) was demonstrated. The embolisation occurred most frequently and most extensively in association with postrheumatic mitral valve disease. Coronary calcific embolisation must be considered in the differential diagnosis of symptoms of ischaemic heart disease in patients suffering from valvular heart lesions.